Increasing proactive prevention in mental health care
From creating an ICS-wide centralised mental health prevention team to better use of digital tools – our consultants consider proactive approaches to support early-stage mental health intervention and reduce hospital admissions.
Mental health and substance misuse problems account for over 20% of the sum of mortality and morbidity in England (Public Health England, 2018), and this figure is sadly expected to rise with the long-term impact of the COVID-19 pandemic.
With mental health services currently facing extraordinary operational pressures and staffing shortages, Posy Putnam and Joe Norbury share their thoughts on why a more proactive approach is needed to improve support for people experiencing mental health challenges, and how digital tools could help.
The need for urgent investment into proactive approaches to mental health support is nothing new - calls for implementing proactive approaches in this area pre-date the NHS Long Term Plan (2018) and were echoed earlier this year in the Fuller Stocktake (2022). However, current provision of mental health support – partly due to resourcing constraints – is still focused on providing support to people whose mental health has already deteriorated to crisis point or extended into severe mental illness.
As a result, people experiencing less severe mental health symptoms can initially be turned away by mental health services as not meeting eligibility thresholds, only to then reappear in crisis later. Recent data from NHS Digital shows that 85% of acute mental health admissions in June of this year had some contact with mental health services in the 12-months prior to admission (Mental Health Services Monthly Statistics, June 2022). This suggests a missed opportunity to proactively support this cohort when they initially present to healthcare services, to prevent future deterioration.
By investing in resource to support this cohort upstream, ICSs can relieve pressures on mental health services downstream (e.g. secondary care) by reducing the number of people going into crisis. This would also have a significant positive impact on patient outcomes and experience.
A joined-up approach
Acknowledging the wider determinants of mental health, any effective proactive approach needs to be underpinned by a holistic support offering.
It is well documented that mental health challenges do not exist in a vacuum and are impacted by a host of other social and economic factors. If mental health services are going to effectively understand what support someone requires to prevent future deterioration, they need to have a robust understanding of the holistic needs of that person. This will enable mental health services to take a truly preventative approach to support, focused on addressing the cause of someone’s mental health ill-health, and not just the symptoms.
The statutory creation of ICSs offers a brilliant opportunity to bring together healthcare teams from across NHS, council, and voluntary services to develop a holistic support offering. Practically, this could mean creating a team with central oversight of mental health prevention and using the "convening power" (as the Fuller Stocktake refers to it) of ICSs to institutionalise relationships between System partners through multi-disciplinary teams.
Using digital tools
While in the long-term a proactive approach would reduce pressures on mental health services, in the short-term there are immediate pressures which need to be alleviated. Investment in digital tools is one way that mental health services can help manage growing waiting lists and provide holistic care with less staff resource. People can be referred to online resources and courses much more quickly than they can be seen in person and, if successful, this can prevent further deterioration. Citizens may also prefer to access face-to-face support virtually, and so investing in digital tools would enable greater personalisaton of care.
However, there are some considerations when thinking about the use of digital tools. It perhaps does not need to be said that digital tools should be seen as complementary to – and not a replacement for – the usual offering of face-to-face mental health support. Similarly, thought needs to be given to how digital tools – and their use – would interact with people who are either digitally excluded, or just reluctant to use a computer or phone to manage their mental health needs.
Overall, proactive prevention offers a real opportunity to move provision of mental health support upstream, leading to improved patient outcomes and experience, as well as reducing pressures on mental health services.
Investment in this area needs to be underpinned by a holistic support offering, enabling mental health services to take a truly preventative approach to mental health support. Considered investment in digital tools could also be used to help mitigate current operational pressures faced by mental health services, as well as compliment future approaches to proactive prevention.
Authors: Posy Putnam and Joe Norbury, The PSC Transformation Team
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